Make a Referral

Looking to make a referral? Want to book an appointment on behalf of someone else? Complete the quick and easy  Referral Booking Form below. Thank you!

If you are an individual or organisation referring a third party individual for one-to-one help and support (see the Services and Support sections in the Menu above for  information on the one-to-one services provided), please complete the Referrer Details and Client Details Sections below to make an appointment. Please seek permission from the individual you are referring before getting in touch.


 

If you are making an appointment for yourself, please complete the  Appointment Booking Form. We will respond within 2-3 working days (excluding weekends).

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Please ensure you complete all sections marked * as the form will not send if these sections are not completed. A message will appear below when your form has been sent to us successfully.  We will ALWAYS reply to your email, so if you don't get a reply within 2-3 working days, please check your spam folder or resend your message. Thank you.

 
 
 
 
 
 
 
 
 
 
Client (self-funding)
Another individual (please specify in the box below **)
Referring Organisation/Company (please specify below **)
Other (please specify below **)
 
Yes
No
Maybe (please specify below **)
 
 
 
Client Only
Referring Organisation/Company
Both Client and Organisation/Company
Other (please specify below **)
 
 
I confirm the above
 
 
 
 
 
 
 
 
 
 
Yes
No
 
 
Yes
No
Awaiting Treatment
 
 
Yes
No
 
 
 
 
 
CBT (Cognitive Behavioural Psychotherapy)
Integrative Therapy
General/Humanistic/Person-Centred Counselling
Existential/Exploratory Therapy and Counselling
Rewind Trauma Therapy
Systemic Therapy (from March 2021)
Clinical Hypnotherapy
Solution-Focused Brief Therapy
Stress Management Therapy/Coaching
Coaching
Couples Counselling and Relationship Therapy
Group Therapy (subject to interest)
Online Therapy and Counselling
Email Therapy and Counselling
Single Session Therapy
Not Sure
Other (please specify below **)
 
 
Morning
Afternoon
Evening
Other (please specify below **)
 
 
Face-to-face
Online
I am happy to access either face-to-face or online appointments
 
 
 
Yes
No
 
Yes
 
 
 
 

CLIENT DETAILS SECTION

REFERRER DETAILS SECTION